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Management

Active treatment depends on the severity of the illness. Cultures should be taken from the vagina, cervix, perineum and nasopharynx. The patient should be referred to a major centre if ‘shock’ develops. Otherwise the vagina must be emptied, ensuring there is not a forgotten tampon, cleaned with a povidone–iodine solution tds for 2 d, and di(flu)cloxacillin or vancomycin antibiotics administered for 8–12 d.

Temporomandibular joint dysfunction

Refer to the techniques on treatment of TMJ dysfunction. Most effective and simplest method is placing a piece of soft wood (e.g. carpenter's pencil) firmly against back molars and biting rhythmically on the object with a grinding movement for 2–3 mins at least 3 times a day.